One thing EMRU DESPERATELY needs

I have no problem with Matt pointing out the difference in scalability between Access and SQL. That is a right and proper topic for a forum in which the "movers and shakers" of the EMR world discuss the fine points of EMR design. In fact, I have found Matt's comments to be quite educational at times.

Insistence on proper detail in a discussion between two EMR gurus is appropriate! I was only pointing out why average users might be intimidated from posting their experiences with their EMR here, understanding that their comments are going to be subjected to that degree of scrutiny.

Let's say that two users are talking about Amazing Charts and one of them (me) says that it can be used in a client/server fashion. Well, it can, in a general sense. But, people who work with relational databases every day have a little different definition of "client/server" than the general public, and they're bound to chime in about it. Well, this may be very correct, and educational to the rest of us.

However (if you'll permit me another analogy), it's also like two (non-medical) people having a discussion in which one of them sensibly states that "oxygen is carried by the blood." At which point, an internist steps between them and says, "Ahem, oxygen is actually carried by red corpuscles." At which point the hematologist says, "It's actually the hemoglobin tetramer in the red blood cell, and each tetramer only binds four oxygen molecules." And then another hematologist pops up and says, "What about myoglobin, you numbskull? You forgot myoglobin!" (Insert Three Stooges slapfest here).

I don't have a solution here. I'm just observing a phenomenon which may explain why your "average user" doesn't post here much.

I would agree with that comment.  Because we as vendors don't like a particular platform or design, often because from a architecture standpoint these programs are nightmare like.

That being said, you are absolutely correct in that users would not want to post here because they would say:

"I am Amazed at Amazing Charts, it has allowed me to automate my 2 physician practice beyond anything we ever imagined.  At only $995 for first provider and all add-ons we only spent $2,500 putting it in.  This is  the best $2,500 I have spent in a long time".

And the Response would not be:

"Yea, I use Amazing Charts and it is great........,"

It would be more like:

"Amazing Charts runs on the Jet Database, how could you select a inferior architecture to run your mission critical practice.  How were you able to have 5 PC''s using this software for over 2 years without much issue.  After all, it runs on Microsoft Jet Database Engine, come on man, everyone knows SQL Server is king.  Did you not know that really your system should not be running so well for you."

My point is, this approach does not lend itself to real input.  Its like someone coming on the site and saying:

"EMR XYZ web portal stinks, but I love the way it works to run my practice day to day.  What have anyone of you experienced specifically with EMR XYZ or your EMR to deal with this issue."

And the answers are:

"Our EMR happens to handle this in the following Manner......"  This could be appropriate.

Or

"The way we deveoped the Portal was with the following features in mind......"

Or

"We are the best EMR in the market, how the hell could you have spent so much on EMR XYZ without a good portal, you should look at switching because....."

My point is we should really consider talking more about EMR Software from a users percpective and not necessarily pick them apart technically.  Unfortunately, so many EMR's were engineered by Doctors and then written by non-professional Developers at first, there foundation is weak at best, but we should not point that out every fricken time a end user posts a positive experience with a EMR.

Brendon, your note was excellent, and should have ended with this line: "My point is we should really consider talking more about EMR Software from a users percpective and not necessarily pick them apart technically." But then you had a "professional EMR programmer" seizure and put in the last line-

>>> Unfortunately, so many EMR's were engineered by Doctors and then written by non-professional Developers at first, there foundation is weak at best, but we should not point that out every fricken time a end user posts a positive experience with a EMR.

Yup, "every fricken time"... Kind of makes your whole note into one condescending burp.

When it comes to EMR, doctors don't know anything. They aren't "professional developers". Heck, AC is written by a family practitioner, so its foundation is weak and thus it really sucks, but LET'S NOT MENTION IT!  Who cares about the thousands of users that are happy and the low deinstall rate when "professionally developed" EHRs with up to a 40% deinstallation rate, an SQL backend, and a CDC certified growth rate as an industry which was FLAT since 2005??!!! Yup, who cares...

My own, currently a MS Access program, which has worked well throughout 18 years in my office under 2 differnet platforms (Paradox for DOS then MS Office), which flies on a P2P network with an Access backend and 8 computers must be total junk. Yup, I'm just making things up, then.

It would be great to have more user input in EMR Update and that is a fact. If anyone would like to do a user interview, please contact me. Originally, we wanted to do more of these. Remember that even the EMR vendors are not really public figures who are expected to give press conferences, and that goes double for EMR users. I hope more and more members will remember to stay with us once they adopt an EMR. My goal is always to try and help doctors picture what it feels like to own an EMR. For most, it is a great feeling!

Al,

Actually no its not conenscending or insulting.  You may take it as that, but that is your decision.  There is a set of rules for Architecture that apply that you don't get just opening up a program and writing interfaces for your needs.  You product and especially AC is an example of how development can be started on Jet Databases and work.

More importantly, I am not a true developer, and I would never trust myself to develop on a Production Mission Critical Application.

That being said, as I stated clearly, AC is one of the best examples of how a Physician can develop a application that performs to Mission Critical Standards for its intended audience, and does so very well.

Therefore, when users of AC post great things about it, we should not go down the architecture road.  By the way AC is not a good example anymore because they are in the process of professionally redeveloping the product, and obviously they have in there newer versions hired Professional Developers.

A professional developer adheres to strict standard of coding and rules that cannot be broken, as the same, with the English Language, and when broken are very hard for those who understand it to accept.

There are many Doctors who had a idea, like Dr. Winn, Dr. Oates, and many others who employed Developers to write the application.

I would stand firm in the position that in enterprise environments architecture is important, but in a single site deployment, even with a good number of stations architecture is less important.  Many practices, the majority for that matter, fall in this category.  Therefore, I don't see where architecture is the number one criteria for user satisfaction with a EMR.

I would have to say it is more support after the sale that probably is the number one issue.

Robert I will see if some of our busy practices can give you interview on there implementation of EMR/EHR.

>>> A professional developer adheres to strict standard of coding and rules that cannot be broken, as the same, with the English Language, and when broken are very hard for those who understand it to accept.

I pretty much adhere good database normalization, but take issue with die-hard strict granularity. The latter goes against my needs as a physician, in which inking and free flow text would go better with workflow issues. One has to wonder if the strict standard of coding is that important...

Sometimes programmer docs can be in the best position when it comes to database construction and even better, pricing. They understand how docs need more affordable systems- Matt and his pay-per-record, David and his 90 money-back-guarantee CCHIT certified EMR for $8000 a license, and Jon with his $995 EMR.

alborg:

They understand how docs need more affordable systems- Matt and his pay-per-record, David and his 90 money-back-guarantee CCHIT certified EMR for $8000 a license, and Jon with his $995 EMR.

I was only recently made aware of Dr. David Winn's 90 day money-back-guarantee on e-MDs. Excellent spirit of fairness and dedication to user satisfaction, Dr. Winn!

In a recent interview with Mark Anderson, Mark stated that the e-MDs sales and performance contracts required the least amount of changes or additions by him in negotiations.

In other words, of all the contracts he sees, the e-MDs contracts start out as the most fair in the first place.

Based on such a beginning of trust, it is no wonder that e-MDs users are normally so happy with their choice. Would I like to interview some e-MDs users? As they say in Minnesota, "You bet."

 You don't need a 90 money back guarantee if you allow a 90 day free trial and let the user try the program.   

Grunualarity, at the cost of higher physician input, is unacceptable to me also.  i believe such items are excessive.   I think you will find many afforadable EMR/EHR's under 10K now.  eMedRec with Dragon Embedded Medical Version and soon Active Ink lists for under $7,500 and is now priced at $5,000 for the solo provider, including the Dragon.  This includes Enterprise Document Imaging, PDF Manipulation, Fax, Scripts Notes everything.  So I really don't think price is what is stopping physicians, its something else.

Price is a separate issue from Database Design and architecture.  But as I said  I don't think for smaller practices this is necessarily a show stopper.  As to money back, many EMR contracts provide for this, ours does for those who demand it, and it usually is contingent on some trigger point being met.

regards,
Brendon

As to eMds 90 day guarantee, I applaud it and it is a great indication of the road ahead.  The buyer will have more power as we continue this slowdown in the market.  We were at 25%-30% market penetration and that number has not increased very much.

I think you will be seeing a shakedown in the industry.  Many EMR companies will go bankrupt or consolidate.  We will see real soon where there loyalties lie when the you know what begins to hit the fan.  I think David is making a very good move here to help assure weary consumers that he stands behind his product.  Good job guys at eMds, maybe others should follow this initiative. 

Regards,
Brendon